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General NPI Number Information
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NPI Number | 1851654909
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED CHILDREN YOUTH & FAMILIES DEVELOPMENT PROGRAM
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 7815 PARKWOOD DR
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City | LITTLE ROCK
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State | AR
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Zip | 72204-3462
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Country | US
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Telephone | 501-350-7687
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Fax |
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Provider Business Mailing Address
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Address Line | 7815 PARKWOOD DR
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City | LITTLE ROCK
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State | AR
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Zip | 72204-3462
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Country | US
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Telephone | 501-350-7687
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. WANDA MARIE HOBBS
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Credential |
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Telephone | 501-350-7687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2729
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License Number State | AR
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